Development and Validation of the Community PrEP-Related Stigma Scale (Community-PSS)

Algarin, Angel B.; Shrader, Cho Hee; Hackworth, Benjamin T.; Varas-Díaz, Nelson; Fennie, Kristopher; Sheehan, Diana M.; Ibáñez, Gladys

doi:10.1521/aeap.2021.33.2.120

Cited by 10 publications

(9 citation statements)

References 20 publications

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“…Klein and Washington's shortened 11-item PrEP Stigma Scale [38] identified two highperforming dimensions of stigma, including a dimension of interpersonal concerns, which aligns with our interpersonal stigma dimension (factor 1). Our PrEP norms dimension aligns with several other measures, which have PrEP user stereotypes and community norms to be key dimensions of PrEPrelated stigma [17,22,25]. Others have identified dimensions of PrEP stigma unmeasured in our study but important for future research.…”

Section: Discussionsupporting

confidence: 76%

“…Others have identified dimensions of PrEP stigma unmeasured in our study but important for future research. For example, Algarin et al.’s multidimensional Community PrEP‐Related Stigma Scale [25] identified a dimension of positive community perceptions of PrEP.…”

Section: Discussionmentioning

confidence: 99%

“…Others have identified dimensions of PrEP stigma unmeasured in our study but important for future research. For example, Algarin et al's multidimen-sional Community PrEP-Related Stigma Scale [25] identified a dimension of positive community perceptions of PrEP. We found that PrEP-related stigma was associated with sex worker identity, and that PrEP-related stigma was generally more prevalent among FSW than among MSM or AGYW.…”

Section: Discussionmentioning

confidence: 99%

“…Adjusted models included all variables found to be associated with PrEP-related stigma in unadjusted models based on a cut-off of p <0. 25.…”

Section: Factors Associated With Stigmamentioning

confidence: 99%

“…This has implications for the broader HIV care continuum, given the potential for PrEP services to improve rates of HIV screening and diagnosis [21]. However, where PrEP-related stigma scales have been developed, they have only been validated among United States (U.S.) populations [17,[22][23][24][25]. Indeed, we identified only one study from SSA, which used a dedicated scale to measure PrEP-related stigma, which was adapted from scales developed for U.S. populations [26].…”

Section: Introductionmentioning

confidence: 99%

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Adaptation and psychometric evaluation of a scale to measure oral pre‐exposure prophylaxis‐related stigma among key and vulnerable populations in Kenya

Atkins

Kan

Musau³

et al. 2022

J Int AIDS Soc.

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Introduction As oral pre‐exposure prophylaxis (PrEP) services scale up throughout sub‐Saharan Africa (SSA), clients continue to face challenges with sustained PrEP use. PrEP‐related stigma has been shown to influence engagement throughout the HIV PrEP care continuum throughout SSA. Validated quantitative measures of PrEP‐related stigma in SSA are of critical importance to better understand its impacts at each stage of the HIV PrEP care continuum. This study aimed to psychometrically evaluate a PrEP‐related stigma scale for use among key and vulnerable populations in the context of a Kenya national PrEP programme. Methods As part of a larger prospective cohort study nested within Kenya's Jilinde programme, this study used baseline data collected from 1135 participants between September 2018 and April 2020. We used exploratory factor analysis to evaluate the factor structure of a PrEP‐related stigma scale. We also assessed convergent construct validity of the PrEP‐Related Stigma Scale by testing for expected correlations with depression and uptake of HIV services. Finally, we examined the relationship between PrEP‐related stigma and key demographic, psychosocial and behavioural characteristics. Results We identified four dimensions of PrEP‐related stigma: (1) interpersonal stigma, (2) PrEP norms, (3) negative self‐image and (4) disclosure concerns. The scale demonstrated strong internal consistency (α = 0.84), was positively correlated with depressive symptoms and negatively correlated with uptake of HIV services. Multivariable regression analysis demonstrated associations between PrEP‐related stigma and sex worker identity. Conclusions The adapted and validated PrEP‐Related Stigma Scale can enable programmes to quantify how PrEP‐related stigma and its dimensions may differentially impact outcomes on the HIV PrEP care continuum, evaluate stigma interventions and tailor programmes accordingly. Opportunities exist to validate the scale in other populations and explore further dimensions of PrEP‐related stigma.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Adjusted models included all variables found to be associated with PrEP-related stigma in unadjusted models based on a cut-off of p <0. 25.…”

Section: Factors Associated With Stigmamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Adaptation and psychometric evaluation of a scale to measure oral pre‐exposure prophylaxis‐related stigma among key and vulnerable populations in Kenya

Atkins

Kan

Musau³

et al. 2022

J Int AIDS Soc.

View full text Add to dashboard Cite

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The development of a conceptual framework on PrEP stigma among adolescent girls and young women in sub‐Saharan Africa

Hartmann,

Nyblade,

Otticha

et al. 2024

J Int AIDS Soc.

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IntroductionStigma is a well‐known barrier to HIV testing and treatment and is an emerging barrier to pre‐exposure prophylaxis (PrEP) use. To guide future research, measurement and interventions, we developed a conceptual framework for PrEP stigma among adolescent girls and young women (AGYW) in sub‐Saharan Africa, a priority population for PrEP.MethodsA literature review, expert consultations and focus group discussions (FGDs) were conducted to adapt the Health Stigma and Discrimination Framework, describing the stigmatization process nested within the socio‐ecological framework. We reviewed all articles on PrEP stigma and on HIV, contraceptive or sexuality stigma among AGYW from 2009 to 2019. Expert consultations were conducted with 10 stigma or PrEP researchers and two Kenyan youth advisory boards to revise the framework. Finally, FGDs were conducted with AGYW PrEP users (4 FGDs; n = 20) and key influencers (14 FGDs; n = 72) in Kenya with the help of a Youth Research Team who aided in FGD conduct and results interpretation. Results from each phase were reviewed and the framework was updated to incorporate new and divergent findings. This was validated against an updated literature search from 2020 to 2023.ResultsThe conceptual framework identifies potential drivers, facilitators and manifestations of PrEP stigma, its outcomes and health impacts, and relevant intersecting stigmas. The main findings include: (1) PrEP stigma is driven by HIV, gender and sexuality stigmas, and low PrEP community awareness. (2) Stigma is facilitated by factors at multiple levels: policy (e.g. targeting of PrEP to high‐risk populations), health systems (e.g. youth‐friendly service availability), community (e.g. social capital) and individual (e.g. empowerment). (3) Similar to other stigmas, manifestations include labelling, violence and shame. (4) PrEP stigma results in decreased access to and acceptability of PrEP, limited social support and community resistance, which can impact mental health and decrease PrEP uptake and adherence. (5) Stigma may engender resilience by motivating AGYW to think of PrEP as an exercise in personal agency.ConclusionsOur PrEP stigma conceptual framework highlights potential intervention targets at multiple levels in the stigmatization process. Its adoption would enable researchers to develop standardized measures and compare stigma across timepoints and populations as well as design and evaluate interventions.

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Development and Validation of the Youth Pre-Exposure Prophylaxis (PrEP) Stigma Scale

et al. 2022

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Development and Validation of the Community PrEP-Related Stigma Scale (Community-PSS)

Cited by 10 publications

References 20 publications

Adaptation and psychometric evaluation of a scale to measure oral pre‐exposure prophylaxis‐related stigma among key and vulnerable populations in Kenya

Adaptation and psychometric evaluation of a scale to measure oral pre‐exposure prophylaxis‐related stigma among key and vulnerable populations in Kenya

The development of a conceptual framework on PrEP stigma among adolescent girls and young women in sub‐Saharan Africa

Development and Validation of the Youth Pre-Exposure Prophylaxis (PrEP) Stigma Scale

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